Prior tonsillectomy and subsequent risk of breast cancer in females: Systematic review and meta-analysis.

Abstract

10568 Background: Exposure to recurrent infections in childhood was linked to an increased risk of cancer in adulthood. There is also evidence that a history of tonsillectomy, a procedure often performed in children with recurrent infections, is linked to an increased risk of leukemia, and Hodgkin lymphoma. Tonsillectomy could be directly associated with cancer risk or it could be a proxy for another risk factor such as recurrent infections and chronic inflammation. Nevertheless, the role of recurrent childhood infections and tonsillectomy on the one hand, and the risk of breast cancer (BC) in adulthood remain understudied. Our study aims to verify whether a history of tonsillectomy increases the risk of BC in women. Methods: A systematic review was conducted using PubMed, Google Scholar, Scopus, Embase and Web of Science databases from inception through November 2020 to identify the studies which explored the association between history of tonsillectomy and BC in females. The Newcastle Ottawa Scale was used to assess the quality of included studies. Odds ratio (OR) was used to measure effect size. The Random/Fixed effects model was applied to synthesize the associations between tonsillectomy and BC risk based on heterogeneity. Heterogeneity was assessed using the I-squared statistic. A forest plot was generated, and publication bias was assessed. The leave-one-out sensitivity analysis was performed to check if results were driven by a single study. Results: Seven studies with a total of 7259 patients were included in our analysis; out of them, 2200 patients were diagnosed with BC. Patients with a history of tonsillectomy (n = 2843) showed higher subsequent risk of developing BC (OR = 1.252; 95% CI = 1.115 - 1.406; P < 0.001; I2 = 9%) as compared to patients without a history of tonsillectomy (n = 4416). Using the leave-one-out sensitivity analysis to iteratively remove one study at a time, we confirmed that no single study had a substantial influence on the overall effect size. Conclusions: Our study supports and confirms the evidence that a history of tonsillectomy is associated with an increased risk of breast cancer. These findings are also an argument in support of the hypothesis that recurrent childhood infections are linked with adulthood breast cancer.

Tonsillectomy as a risk factor of periodontitis: A population‐based cohort study

“…20,21 Overall, a significantly high risk of post-operative aggressive or acute periodontitis was observed after 4 years of follow-up in pediatric patients receiving tonsillectomy, which can be an overlooked long-term adverse event of tonsillectomy, aside from other well-established local and systemic complications of tonsillectomy. 4,[9][10][11][12] Our findings are interesting because of the fact that tonsillectomy is not conventionally considered to be drastically affecting the immune functions of children. 22,23 Particularly, although the short-term consequences of tonsillectomy are well documented and managed, its long-term side effects have not been fully investigated.…”

“…In conjunction with these previous studies on long‐term systemic and local complications following tonsillectomy, guidelines and suggestions for the conservative management of tonsillar diseases with antibiotics or other pharmaceutical interventions before tonsillectomy have been initiated 38 . Thus, echoing the insights of immune‐related long‐term complications of tonsillectomy that have been identified systemically or in other organs, 4,9–12 we recommend regular follow‐ups and patient education when a tonsillectomy is performed.…”

“…Based on findings in the sub‐outcome analysis, it is pinpointed that such events of post‐tonsillectomy periodontitis consisted of mostly aggressive and acute periodontitis, which were subtypes of periodontitis that were indeed more prevalent in children or adolescents, especially those with underlying infectious diseases such as tonsillitis 20,21 . Overall, a significantly high risk of post‐operative aggressive or acute periodontitis was observed after 4 years of follow‐up in pediatric patients receiving tonsillectomy, which can be an overlooked long‐term adverse event of tonsillectomy, aside from other well‐established local and systemic complications of tonsillectomy 4,9–12 …”

“…4,5 Short term benefits of tonsillectomy includes improvement in sleep outcomes for patients with OSA and pharyngitis among patients with recurrent pharyngitis. 6,7 However, recent studies indicate that tonsillectomy at a young age can alter the development of NALTs and humoral immunity, which eventually leads to higher risks of developing several diseases in adults, such as respiratory tract infections, 8 deep neck space infections, 4 irritable bowel syndrome (IBS) and Crohn's disease (IBD), 9,10 Behcet's Disease, 10 breast cancer, 11 and Hodgkin's lymphoma. 12 Particularly, tonsillectomy has been shown to increase the risk of respiratory diseases thrice; likewise, adenoidectomy has been shown to increase the risk of chronic obstructive pulmonary disease (COPD), upper respiratory diseases, and conjunctivitis twice.…”